The long-term goal of this proposed project is to better clarify the role of both individual and community social determinants with health outcomes in 4337 non-Hispanic African-Americans and non-Hispanic Caucasians with OA. This will be accomplished in a unique, prospective, population-based study of knee and hip OA in Johnston County, a predominantly rural county in North Carolina. This goal will be accomplished using multi- methodology through the following aims: 1) to determine whether there is an independent association between community and individual SES with knee and hip OA prevalence; 2) to determine whether there is an independent association between community and individual SES with arthritis severity and progression; 3) to determine whether there is an independent association between community and individual SES with disability; 4) to determine whether there is an independent association between SES (community and individual) and mortality; 5) to develop a measure of observational assessment for community health characteristics and develop a scale to assess participants' perceptions of these characteristics; 6) to test hypothesized mediators of relationships between individual and community SES with knee and hip OA prevalence and outcomes. PUBLIC HEALTH RELEVANCE: The gap in health outcomes is multifactorial, incompletely understood, and potentially difficult to redress in its entirety. However, a better understanding of the individual and community factors that influence health outcomes in racial and ethnic groups will provide an invaluable foundation for designing interventions and creating policies to reduce these gaps.